Why Is This Important?

The impacts of overwhelming stress on the brain continue into adulthood and can have generational impacts. As Alaska children exposed to emotional neglect grow up, they may find negative ways to cope with their damaged stress responses. A study found that neglect can have severe, deleterious short- and long-term effects on children's cognitive, socio-emotional, and behavioral development. Relative to physically abused children, neglected children have more severe cognitive and academic deficits, social withdrawal and limited peer interactions, and internalizing problems.^2^ A study found that children's perceptions of emotional neglect and control are associated with over twice the odds of psychiatric disorder at age 15.^3^ Adverse Childhood Experiences (ACEs) are potent risk factors for involvement in domestic violence, alcohol dependence, and suicide attempts. If individuals abused as children start families of their own, they can perpetuate ACEs for another generation.^4^
The Adverse Childhood Experiences (ACE) Study, a collaborative between the Centers for Disease Control and Prevention and Kaiser Permanente's Health Appraisal Clinic in San Diego, assessed associations between childhood maltreatment and later-life health and well-being.^1^ It is critical to understand how some of the worst health and social problems can arise as a consequence of adverse childhood experiences. Sixteen of the [http://hss.state.ak.us/ha2020/ Healthy Alaskans 2020] leading health indicators have been shown through peer reviewed journal articles to be negatively impacted by adverse childhood experiences. Alaska takes on the burden of approximately $82 million in costs (e.g., health care costs, welfare costs, special education costs) each year due to nonfatal child maltreatment. Recognizing the connections between ACEs and health outcomes and their associated costs is likely to improve efforts towards prevention and recovery.^5^[[br]]
[[br]]
----
{{class .SmallerFont
1. U.S. Centers for Disease Control and Prevention (CDC). Adverse Childhood Experiences (ACE) Study. [http://www.cdc.gov/violenceprevention/acestudy/index.html]. Updated April 1, 2016. Accessed April 26, 2016.
2. Hildyard K, Wolfe DA. Child neglect: developmental issues and outcomes. Child Abuse & Neglect 2002;26:679-95.
3. Young R, Lennie S, Minnis H. Children's perceptions of parental emotional neglect and control and psychopathology. Journal of Child Psychology and Psychiatry 2011;52(8):889-97.
4. Alaska Department of Health and Social Services. Alaska Mental Health Board and the Advisory Board on Alcoholism and Drug Abuse. Investing in prevention: working together in early childhood for healthy Alaskan children, families, and communities 2015. [http://dhss.alaska.gov/abada/ace-ak/Documents/State_Interagency_Prevention_2015.pdf]. Accessed April 26, 2016.
5. Sidmore P. Alaska Department of Health and Social Services. Alaska Mental Health Board and the Advisory Board on Alcoholism and Drug Abuse. Economic costs of adverse childhood experiences in Alaska. [http://dhss.alaska.gov/abada/ace-ak/Documents/ACEsEconomicCosts-AK.pdf]. Accessed April 26, 2016.
}}

Chart

Data Table

Data Notes

Notes

** = Data not available due to fewer than 50 respondents in the denominator.
Geographic descriptions of boroughs and census areas can be found at: [http://dhss.alaska.gov/dph/InfoCenter/Pages/ia/brfss/geo_bca.aspx].

Data Interpretation Issues

The preamble to each of the Adverse Childhood Experiences (ACEs) question was: "I'd like to ask you some questions about events that happened during your childhood. This information will allow us to better understand problems that may occur early in life, and may help others in the future. This is a sensitive topic and some people may feel uncomfortable with these questions. At the end of this section, I will give you a phone number for an organization that can provide information and referral for these issues. Please keep in mind that you can ask me to skip any question you do not want to answer. All questions refer to the time period before you were 18 years of age. Now, looking back before you were 18 years of age ---"
While the individual adverse childhood experience (ACE) an Alaska adult may have experienced is important, the strength of the research lies in the often multiple ACEs an individual has during childhood: "The ACE score, a total sum of the different categories of ACEs reported by participants, is used to assess cumulative childhood stress. Study findings repeatedly reveal a graded dose-response relationship between ACEs and negative health and well-being outcomes across the life course...Dose response describes the changes in an outcome (e.g., alcoholism) associated with differing levels of exposure (or doses) to a stressor (e.g., ACEs). A graded dose-response means that as the dose of the stressor increases the intensity of the outcome also increases."^1^
The ACEs question on emotional neglect was asked in 2014 and 2015.[[br]]
[[br]]
----
{{class .SmallerFont
1. U.S. Centers for Disease Control and Prevention (CDC). Adverse Childhood Experiences (ACE) Study. [http://www.cdc.gov/violenceprevention/acestudy/index.html]. Updated April 1, 2016. Accessed April 26, 2016.}}

Health Indicator Definition

Definition

Percentage of adults 18 years of age and older who responded "Once" or "More than once" on the [http://dhss.alaska.gov/dph/Chronic/Pages/brfss/default.aspx Behavioral Risk Factor Surveillance System (BRFSS)] to the question: "How often did you feel that your parents or adults in your home did not love you or appreciate you?"

Numerator

Weighted number of adults (18+) who responded "Once" or "More than once" on the BRFSS to the question: "How often did you feel that your parents or adults in your home did not love you or appreciate you?"

Denominator

Weighted number of adults (18+) who responded to the emotional neglect question on the BRFSS, excluding those with missing or "Refused" responses. Those who responded "Don't know/Not sure" are defined as a negative response for that ACE category.

Current Outlook

How Are We Doing?

In 2014-2015 combined, 15.8% of Alaska adults reported having experienced childhood emotional neglect. Female adults reported a significantly higher prevalence of 20.1% of experiencing childhood emotional neglect, while 11.7% of male adults reported similar exposure. Those adults who were divorced or separated reported significantly higher prevalence of childhood emotional neglect at 22.9% than adults who were married with exposures of 13.9%. Employment status was also associated with prevalence of emotional neglect: 14.2% of employed adults had been emotionally neglected but 31.4% of those unable to work reported exposure. The prevalence of emotional neglect was significantly lower in the Southwest region than in the Anchorage-Matanuska-Susitna region for both all Alaska adults (9.5% versus 16.3%) and Alaska Native adults (8.6% versus 21.3%).
Rates of emotional neglect during childhood from the BRFSS are initially presented for all Alaskans and Alaska Native people for the combined 2-year period from 2014-2015. Subsequent analyses were conducted for demographic subpopulations (i.e., sex, age, race/ethnicity, ethnicity, marital status, education, employment status, income, and poverty status).
Crosstabulations were also conducted for 2-year averages by body mass index, current smoking, sexual orientation, and disability. Significant differences were evident in these contrasts.
Rates of childhood emotional neglect by regions of Alaska are presented for all Alaskans and Alaska Native people for the 2-year average of surveys conducted between 2014-2015: 1) 7 Alaska Public Health Regions, 2) 5 Metropolitan and Micropolitan Statistics Areas and rural remainder, 3) 10 behavioral health assessment regions based upon aggregations of 20,000 population, 4) 29 boroughs and census areas, and 5) 12 tribal health organization regions.

How Do We Compare With the U.S.?

There are no national statistics on emotional neglect available.

Health Improvement Resources

What Is Being Done?

The [http://hss.state.ak.us/ha2020/ Healthy Alaskans 2020] initiative developed strategies by content experts to reduce child maltreatment. Public health partners around the state are aligning work around these approaches adapted by Alaska's unique needs. Alaska strategies include:
1. Promote screening and monitoring for child abuse in primary care offices and public health clinics.
2. Use the [http://dhss.alaska.gov/ocs/Pages/families/default.aspx Strengthening Families Protective Factors] framework in family programs.
3. Expand home visiting programs.
4. Expand and strengthen quality early childhood programs.
5. Train providers on brain development, adverse childhood experiences (ACEs), and resiliency.^6^
Alaska has many groups working on preventing childhood trauma and easing the effects of damage already done. Here are a few examples (as of early 2015):^7^
The Division of Behavioral Health has promoted trauma-informed care for several years. Efforts include development of "Trauma 101" and "Trauma 201" curriculum for behavioral health providers, used around the state.
[http://tundrapeace.org/programs/taav/ Teens Acting Against Violence (TAAV)] is a violence-prevention and youth empowerment program at the [http://tundrapeace.org/ Tundra Women's Coalition] for teenagers living in Bethel. Participation is voluntary and open for any interested teens age 12-18.^8^[[br]]
[[br]]
----
{{class .SmallerFont
6. Alaska Department of Health and Social Services. Healthy Alaskans 2020. [http://hss.state.ak.us/ha2020/]. Accessed April 26, 2016.
7. Alaska Department of Health and Social Services. Alaska Mental Health Board and the Advisory Board on Alcoholism and Drug Abuse. Adverse childhood experiences - overcoming ACEs in Alaska. [http://dhss.alaska.gov/abada/ace-ak/Documents/ACEsReportAlaska.pdf]. Published January 2015. Accessed April 26, 2016.
8. Teens Acting Against Violence. Tundra Women's Coalition - Crisis Line - 1-800-478-7799 or 907-543-3456 website. [http://tundrapeace.org/programs/taav/]. Accessed April 26, 2016.
}}

Evidence-based Practices

Recovering from trauma is a challenging process. Building resiliency and having a supportive adult in your life can help with recovery. Positive experiences - such as exposure to environments rich in a range of developmentally appropriate opportunities for social play and exploration - can compensate for and even reverse the negative consequences of stress. Efforts during childhood are essential because over time, some stress-induced detriments are increasingly resistant to reversal.
Trauma-focused cognitive behavioral therapy (TF-CBT) is an evidence-based treatment approach shown to help children, adolescents, and their caregivers overcome trauma-related difficulties. It is designed to reduce negative emotional and behavioral responses following traumatic events. The treatment - based on learning and cognitive theories - addresses distorted beliefs and attributions related to the abuse and provides a supportive environment in which children are encouraged to talk about their traumatic experience. TF-CBT also helps parents who were not abusive to cope effectively with their own emotional distress and develop skills that support their children.^9^
ACEs are best addressed through a coordinated effort to implement prevention programs across multiple settings and populations. Research indicates the majority of health and social challenges are interconnected and often share the same root causes. The following steps need to be taken to address these root causes:
1. Support quality early childhood programs.
2. Ensure access to health care including behavioral health care.
3. Strengthen capacity for social emotional learning throughout Alaska's schools.
4. Maintain and expand prevention efforts that have been proven to be effective.^4^
The [http://www.cssp.org/ Center for the Study of Social Policy] spent two years researching and identifying five protective factors that prevent child abuse and neglect. These are: parental resilience, social connections, concrete support in times of need, knowledge of parenting and child development, and social and emotional competence of children. Research studies support the common-sense notion that when these protective factors are well established in a family, the likelihood of child abuse and neglect diminishes. Research shows that these protective pactors are also "promotive" factors that build family strengths and a family environment that promotes optimal child and youth development.^10^[[br]]
[[br]]
----
{{class .SmallerFont
4. Alaska Department of Health and Social Services. Alaska Mental Health Board and the Advisory Board on Alcoholism and Drug Abuse. Investing in prevention: working together in early childhood for healthy Alaskan children, families, and communities 2015. [http://dhss.alaska.gov/abada/ace-ak/Documents/State_Interagency_Prevention_2015.pdf]. Accessed April 26, 2016.
9. Child Welfare Information Gateway. Trauma-focused cognitive behavioral therapy for children affected by sexual abuse or trauma. [https://www.childwelfare.gov/pubPDFs/trauma.pdf]. Accessed April 26, 2016.
10. Alaska Department of Health and Social Services. Office of Children's Services. Strengthening families. [http://dhss.alaska.gov/ocs/Pages/families/default.aspx]. Accessed April 26, 2016.
}}

The information provided above is from the Alaska Department of
Health and Social Services' Center for Health Data and Statistics,
Alaska Indicator-Based Information System for Public Health (Ak-IBIS)
web site (http://ibis.dhss.alaska.gov). The information published
on this website may be reproduced without permission. Please use
the following citation:
"
Retrieved
Thu, 21 March 2019
from Alaska Department of Health and Social Services, Center for
Health Data and Statistics, Alaska Indicator-Based Information
System for Public Health web site: http://ibis.dhss.alaska.gov
".

Content updated: Wed, 14 Dec 2016 15:28:26 AKST

The information provided above is from the Alaska Department of Health and Social Services' Center for Health Data and Statistics AK-IBIS web site (http://ibis.dhss.alaska.gov/). The information published
on this website may be reproduced without permission. Please use the following citation:
"
Retrieved
Thu, 21 March 2019 12:27:44
from Alaska Department of Health and Social Services, Center for Health Data and Statistics, Indicator-Based Information
System for Public Health Web site: http://ibis.dhss.alaska.gov/
".